[Choice of instruments in ophthalmologic echography].
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Biomedical subjects
Publications and source records attributed to J Poujol.
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Echography was performed on 38 eyes enucleated for suspected retinoblastoma. The two major criteria for the echographic diagnosis of retinoblastoma were the presence of intratumoral calcifications and normal axial length of the eye with respect to age. No errors in diagnosis were made on the 25 eyes considered to be cases of retinoblastoma by echographic criteria. Two doubtful cases turned out to be pseudogliomas and in 11 cases the diagnosis of pseudoglioma by ultrasonic examination was confirmed by histopathology. The results are compared with those of 67 cases of retinoblastoma examined from 1964 to 1977 by one of the authors and to other published series. This study helps to demonstrate the importance of echography in the diagnosis of retinoblastoma and in the differentiation between retinoblastoma and pseudoglioma .
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B-mode ultrasound has only really become common and easy to perform vs. immersion techniques since 1972 when contact B-scan was introduced in ophthalmology. Ocular exploration became easier and more complete, especially as far as topographic evaluation is concerned. B-scan allows accurate diagnoses in the pathology of the optic nerve head and an easy evaluation of the size of recti muscles, whereas quantitative data are still better obtained with A-mode. The best solution at present seems to be to use both methods until gray-scales improve enough for B-scan to be used alone.
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The survey of a population of 7 patients with malignant glaucoma, whose 3 were bilateral, showed that the total length of these eyes was weaker, the corneal radius shorter, the anterior chamber more shallow and the insertion of the lens more anterior than that of eyeballs with angle-closure glaucoma on the whole. These latter, we must remind, are already smaller than normal eyes. But this lessening of size does not affect the corneal diameter which remains always normal. And the lens, which is greater than normally in the angle-closure glaucoma, in the contrary is normal or smaller in the malignant glaucoma. The authors think that this little size of the lens allows it to be dislocated anteriorly through the limbal ring after the operation, and so is the cause of the post-surgical malignant glaucoma.
Ultrasonography can provide priceless information about a retinal detachment when the fundus is invisible because of a cataract or an unclear vitreous. The exploration of an eye with A-scan ultrasonography is a long and careful procedure which is made step by step along the meridians, then along the parallels of the eyeball. Quantitative ultrasonography is necessary to separate the echoes of the vitreous opacities and of the detached retina. The B-scan gives the same information - except the biometric data - in a much shorter time and is now available without the interposition of water between the patient and the probe. It also permits an easy diagnosis of the choroidal detachment. After the operation, when the media are not clear, A-and B-scan ultrasonography can give an early indication of whether the retina is reattached or not. But at that time a mistake may be made due to the edge of buckling and everyone should be aware of this.
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